USMLE Forum Archives - USMLE Step 2 CK - Dog bite!
Dog bite!
laparotomy - 01-27-08 14:14
A 16 year old girl presents to your emergency department following a dog bite injury to her face and right lower arm. Physical examination shows an approximately 2 cm bite over the patients left zygoma area, and a 2.5cm bite wound on her left proximal part of her upper arm, no vessels or nerves are involved. Patient is stable BP 120/80 Pulse 80.
What are your next steps in management?
laparotomy - 01-27-08 14:14
A 16 year old girl presents to your emergency department following a dog bite injury to her face and right lower arm. Physical examination shows an approximately 2 cm bite over the patients left zygoma area, and a 2.5cm bite wound on her left proximal part of her upper arm, no vessels or nerves are involved. Patient is stable BP 120/80 Pulse 80.
What are your next steps in management?
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#1
Re: Dog bite! InSitu - 01-27-08 19:57 trt prophylacticaly with Amoxicillin/Calvulanate for 5 days, due to fear from Pasturela Multicoida.
-Pasturella Multicoida, occurs after cat or dog bite, and there is an intense inflamatory reaction within 24 hrs of the bite. Pain, swelling, purulent discharge are features.
-Bartonella Hensalae, occurs after cat scratch or bites. Clinical features occur after 3-10 DAYS. . They include papular or vesicular lesion, at the site of injury and proximal Lymphadenpathy.
#2
Re: Dog bite!
laparotomy - 01-27-08 20:38 How will you treat the wound will you suture? Use clips or what?
#3
Re: Dog bite! radhamesramos - 01-28-08 11:53 no sutures...Because of all anaerobics on the saliva. Clean the wound, leave it open and check the dog vaccination status
#4
Re: Dog bite! laparotomy - 01-28-08 15:14 
posted by radhamesramos on 01-28-08 11:53
no sutures...Because of all anaerobics on the saliva. Clean the wound, leave it open and check the dog vaccination status
no sutures...Because of all anaerobics on the saliva. Clean the wound, leave it open and check the dog vaccination status
You are only half right. Facial wounds are sutured.
#6
Re: Dog bite! InSitu - 01-28-08 22:14 posted by laparotomy on 01-28-08 15:14
You are only half right. Facial wounds are sutured.
You are only half right. Facial wounds are sutured.
Yes for cosmetic reason they must be sutured. You dont want a big scar in the face and thats why you treat prophylatically.
#7
Re: Dog bite! laparotomy - 01-29-08 03:37 That was the trick in the question, the two wounds should be treated differently.
#10
Re: Dog bite! funtonic - 02-01-08 15:30 good question, however, based on FA, no therapy is cosmetic reason oriented.
#11
Re: Dog bite! laparotomy - 02-02-08 07:45 posted by funtonic on 02-01-08 15:30
good question, however, based on FA, no therapy is cosmetic reason oriented.
good question, however, based on FA, no therapy is cosmetic reason oriented.
Sorry but what is FA?
#13
Re: Dog bite! laparotomy - 02-07-08 08:38 posted by TheOne on 02-06-08 18:28
First Aid.. The book
First Aid.. The book
You mean that there is no therapy that should be done for cosmetic reasons?
Well I would question that. I dont think you would want to have your face left to heal by secondary intention if I was mauled by a pit bull. Oh yeah it may get infected, so give antibiotics with anaerobic and aerobic cover, but you do need to suture with interrupted stitches not too close together, and if you do get a seroma or mild infection then you can remove 1 or 2 stitches and rinse/clean with an antiseptic (betadine, or hydrogen peroxide "depending on the country")
PS: some countries are against hydrogen perioxide because they say it causes air emboli, I am not sure what is the norm in the U.S.A or for USMLE purposes, anyone?
#14
Re: Dog bite! ammulufy - 06-29-10 21:07 Immediate administration of Rabies vaccine along wid Tetanus inj. i.m.....I think......followed by adequate hydration.
#15
Re: Dog bite! bingousmle - 06-30-10 16:55 giving rabies vaccination is a bit doubtful because the pets are usually vaccinated... there is risk for developing pasturellla infection so should receive antibiotics like augmentin.. keep the wound open..
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